Provider Demographics
NPI:1427578210
Name:PURUSHOTHAMAN RAVICHANDRAN, ABINAYAA (MD)
Entity type:Individual
Prefix:DR
First Name:ABINAYAA
Middle Name:
Last Name:PURUSHOTHAMAN RAVICHANDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 SHETLAND DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5876
Mailing Address - Country:US
Mailing Address - Phone:469-994-2395
Mailing Address - Fax:
Practice Address - Street 1:1804 CHUCKWA DR
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2146
Practice Address - Country:US
Practice Address - Phone:903-893-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT212915390200000X
OK385842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty